<p>The purpose of this study is to find out if the Swedish Air Force and the military aviation industry, Saab Aerosystems, use an HTO perspective in incident investigations. The research objectives are to explore existing organizational and accident models, analyze the reporting system using the models, and suggest possible improvements to the existing incident investigation system. Fishman’s (1999) model for pragmatic studies was used to describe the study’s theoretical approach. Triangulation by literary review, case study and interviews were used to ensure validity and reliability.</p><p>Three models were chosen: Rollenhagen’s HTO model (1997), Leveson’s STAMP (2002), and Shappell and Wiegmann’s HFACS (2000). The models were further tested in the case study, revealing that their usefulness depends on type of incident, and that they leave a lot up to the investigator.</p><p>Interviews were conducted with key individuals at Saab Aerosystems as well as at the Swedish Armed Forces’ Headquarters. The interviews showed that the incident reporting system in question is a well functioning one, mainly due to the blame-free culture, multidisciplinary investigative teams, good feedback and a generally good knowledge of the HTO concept. Difficulties within the organizations exist due to organizational boundaries between the manufacturer and the operator, and recurring structural reorganizations within the Swedish Armed Forces. Saab acknowledges the emphasis on technical issues. The Flight Safety department at the headquarters is currently working with implementing HFACS into the Flight Safety Database.</p><p>Our recommendations for Saab Aerosystems and the Air Force include:</p><p>For Saab Aerosystems:</p><ul><li>Evaluate and learn from existing HTO work within the organization, and incorporate the results into existing processes and instructions for incident investigations.</li><li>Make use of the theoretical models, where applicable, in the processes as well.</li><li>Focus on HFACS in order to synchronize with the Air Force.</li><li>Consider employing an HTO specialist.</li></ul><p>For the Air Force:</p><ul><li>Consider influences from other HTO models, like Rollenhagen’s or Leveson’s models, while still in the development phase of implementing HFACS.</li><li>Perform risk analyses regarding the effects on flight safety when doing reorganizations.</li></ul><p>For both Saab Aerosystems and the Air Force we recommend:</p><p>Use Leveson’s model STAMP for complex and serious incidents, comprising of organizational, human and technical aspects.</p> / <p>Denna studie har som syfte att ta reda på om det svenska Flygvapnet och den militära flygindustrin, Saab Aerosystems, använder ett MTO-perspektiv vid incidentutredningar. Forskningsmålen är att utforska befintliga organisations- och olycksmodeller, att analysera rapporteringssystemet med hjälp av modellerna, samt att föreslå möjliga förbättringar på det existerande incidentrapporterings- och utredningssystemet. Fishmans (1999) modell för pragmatiska studier användes som teoretisk utgångspunkt. För att säkerställa validitet och reliabilitet användes triangulering, bestående av litteraturstudie, fallstudie, samt intervjuer.</p><p>Tre modeller valdes ut: Rollenhagens MTO-modell (1997), Levesons STAMP (2002) och Shappell och Wiegmanns HFACS (2000). Modellerna användes i fallstudien, med resultatet att modellernas användbarhet bedömdes variera beroende på typ av incident, samt att de lämnar mycket åt utredarens erfarenhet.</p><p>Intervjuer genomfördes med nyckelpersoner på Saab Aerosystems och på Försvarsmaktens Högkvarter. Intervjuerna visade att rapporteringssystemet i fråga är väl fungerande, främst tack vare rapporteringskulturen, de multidisciplinära utredningsgrupperna, god återkoppling och en generellt sett god kännedom om MTO-konceptet. Organisatoriska svårigheter är dels gränsdragningen mellan tillverkare och användare, dels återkommande omstruktureringar inom Försvarsmakten. Saab medger också att deras fokus ligger främst på det tekniska. Flygsäkerhetsavdelningen på Högkvarteret arbetar med att införa HFACS i flyg­säker­hetsdatabasen.</p><p>Våra rekommendationer till Saab Aerosystems och till Flygvapnet inkluderar:</p><p>Till Saab Aerosystems:</p><ul><li>Utvärdera och drag lärdom av befintligt MTO-arbete inom organisationen, inkludera dessa resultat i befintliga processer och instruktioner för incidentutredningar.</li><li>Utnyttja fler teoretiska modeller i processen, där så är lämpligt.</li><li>Fokusera på HFACS för att synkronisera med Flygvapnet. <ul><li>Fundera på att anställa en MTO-specialist.</li></ul></li></ul><p>Till Flygvapnet:</p><ul><li>Fundera på att också införa delar av andra MTO-modeller, som Rollenhagens eller Levesons modeller, under implementeringsfasen av HFACS. </li><li>Genomför riskanalyser av påverkan på flygsäkerhet vid omorganisationer.</li></ul><p>Till både Saab Aerosystems och Flygvapnet rekommenderar vi:</p><p>använd Levesons modell STAMP vid mer komplexa och allvarliga incidenter som innefattar organisatoriska, mänskliga och tekniska aspekter.</p>

<p>Statistics showing that in-vehicle driver distraction is a major contributing cause in road accidents is presented. Driver distraction is defined building on the driving theory by Gibson and Crooks. The idea to use driver distraction countermeasures as a way of mitigating the effects of the driver distraction problem is then introduced. A requirement list is formulated with ten requirements that distraction countermeasures should meet. A simplification of regarding distraction as a gaze direction problem makes way for designing an experiment to evaluate two driver distraction countermeasures in which new eye- tracking technology plays a key role. The experiment also makes use of a simulator, a surrogate in-vehicle information system as a distractor, and thirty subjects. The most important dependent measures were in-vehicle glance time and a steering wheel reaction time measure. The evaluated countermeasures – a blue flash at middle of the road position and a kinesthetic brake pulse – could, however, not be shown to meet the most important of the requirements formulated. The lack of effect of the countermeasures in the experiment may either depend on their actual inefficiency or on methodological shortcomings of the experiment. These alternatives are discussed. It is speculated that the biggest problems with the possible lack of actual efficiency have to do with that the theoretical basis for using a flash did not transfer to the driving setting, and that the brake pulse used was too weak. The methodological problems have to do with the non-validated dependent measures used, missing data, nuisance warnings, insufficient distractors, non-precise hypotheses, and difficulties with separating the effect of the countermeasures from the psychological force to look on the road.</p>

<p><strong>Introduktion:</strong> För att en räddningsinsats på olycksplats skall lyckas är en väl fungerande kommunikation nödvändig. Kommunikationen har visat sig vara ett vanligt problem vid utvärderingar av allvarliga händelser. Patientsäkerheten kan äventyras om det brister i informationsflödet mellan aktörerna i vårdkedjan. <strong>Syfte: </strong>Syftet med studien var att undersöka ambulanspersonalens uppfattningar av informationsöverföringen mellan sjukvårdens personal på olycksplats. Studien gjordes för undersöka om det fanns omständigheter som försvårar respektive underlättar informationsöverföringen. <strong>Metod: </strong>Enkätstudie bland ambulanspersonal (n= 103). <strong>Resultat: </strong>Tolv procent  ansåg att informationsöverföringen på olycksplats fungerade helt tillfredsställande. Av respondenterna var det 16,5 % som kände sig tillräckligt utbildade för att leda sjukvården på olycksplats, män kände sig signifikant oftare tillräckligt väl utbildade än kvinnor (p= < 0,02). Det var också fler män än kvinnor som kände sig säkra i rollen som sjukvårdsledning (p=< 0,01).  Det framkom att både mänskliga och tekniska faktorer påverkar kommunikationen samt att olycksplatsens geografiska läge, storlek och typ också hade påverkan. <strong>Konklusion:</strong> Faktorer som försvårar kommunikationen är låg tillit till en del av den tekniska utrustningen samt känslan av att vara otrygg i rollen som sjukvårdsledare. Erfaren personal samt erfarenhet av sjukvårdsledning anses vara faktorer som underlättar kommunikationen.  Fler studier behövs om  kommunikationen på olycksplats och även validerade skalor som mäter kommunikation bör utvecklas. <strong></strong></p> / <p><strong>Introduction: </strong>Well-functioning communication is essential for the success of rescue efforts at the scene of an accident. Problems in communication have proved to be a common occurrence in evaluations of serious incidents. Security of the patient might be adventured if there are problems in the flow of information between the actors in the chain of care. <strong>Purpose:</strong> The purpose of this study was to investigate paramedics’ experiences of the exchange of information within the medical service at the scene of accidents. The study was carried out to investigate if there were circumstances that aggravate or help the transfer of information. <strong>Method:</strong> A survey study among paramedics (n = 103). <strong>Result:</strong> Twelve percent perceived that communication of information worked completely satisfactorily. A total of 16.5 % of respondents felt well enough trained to lead the medical service at an accident scene and men felt significantly more often than women that they were well trained enough for the task (p= < 0,02). There were also significantly more men who felt confident in the roll as leader of the medical service(p=< 0,01).   <strong>Conclusion:</strong> Factors which make communication difficult included diminished trust in technical equipment and feelings of uncertainty in the roll of leader. Experienced personnel and leaders are seen as factors which positively affect communication. More studies concerning communication at accident scenes are needed and also validated scales for the measurement of communication skills.</p>

<p>Being severely burned is a traumatic life event that affects the victim both physically and psychologically. Recovery can be a long process that is dependent in part upon psychological factors, but research in this area is still quite limited. The main aim of the thesis was to explore coping, personality and cognitive processes in long-term and short-term adaptation. The participants were recruited from three separate samples of former and consecutive adult burn patients. </p><p>A questionnaire, the Coping with Burns Questionnaire (CBQ), was developed to retrospectively assess coping. It consisted of six coping factors related in different ways to self-reported health status. Regarding personality, the former patients displayed slightly more Neuroticism than people in general, suggesting an overrepresentation of premorbid neurotic personality traits. Avoidant coping was related to poorer perceived health status, more maladaptive personality traits, and was a strong predictor of psychological symptoms at three months post-burn. Regarding cognitive processes, a moderate attentional bias towards burn-related information was found in the former patients when using the emotional Stroop task. This indicates that the burn may still be an important issue years after the event. Finally, former patients’ reactions to participating in a trauma-related postal survey were investigated. A majority felt that participation was positive or even beneficial, while a small subgroup felt that participation was cumbersome or negative. </p><p>To summarise, although many burn patients adapt well in the long run, the burn may still be a significant theme and the subgroup of Avoidant copers are especially vulnerable. The CBQ seems to be an adequate tool for discerning individuals at risk for poor adjustment. Trauma-related postal questionnaires are well accepted by a majority of former burn patients. Although long-term prospective follow-ups are needed to further validate the results, it is suggested that early screening of psychological factors could be of value in burn care.</p>

Diese tragische Geschichte von einem Jagdunfall, bei dem ein dreizehnjähriger Junge, einziger Sohn seiner Eltern, ums Leben kommt, ist die bekannteste Episode aus der 1975 posthum veröffentlichten Baasdörper Krönk. F.E. Peters hat sie zu Lebzeiten auf Hochdeutsch veröffentlicht. Die Erzählung variiert den Freischütz-Stoff.

Being severely burned is a traumatic life event that affects the victim both physically and psychologically. Recovery can be a long process that is dependent in part upon psychological factors, but research in this area is still quite limited. The main aim of the thesis was to explore coping, personality and cognitive processes in long-term and short-term adaptation. The participants were recruited from three separate samples of former and consecutive adult burn patients. A questionnaire, the Coping with Burns Questionnaire (CBQ), was developed to retrospectively assess coping. It consisted of six coping factors related in different ways to self-reported health status. Regarding personality, the former patients displayed slightly more Neuroticism than people in general, suggesting an overrepresentation of premorbid neurotic personality traits. Avoidant coping was related to poorer perceived health status, more maladaptive personality traits, and was a strong predictor of psychological symptoms at three months post-burn. Regarding cognitive processes, a moderate attentional bias towards burn-related information was found in the former patients when using the emotional Stroop task. This indicates that the burn may still be an important issue years after the event. Finally, former patients’ reactions to participating in a trauma-related postal survey were investigated. A majority felt that participation was positive or even beneficial, while a small subgroup felt that participation was cumbersome or negative. To summarise, although many burn patients adapt well in the long run, the burn may still be a significant theme and the subgroup of Avoidant copers are especially vulnerable. The CBQ seems to be an adequate tool for discerning individuals at risk for poor adjustment. Trauma-related postal questionnaires are well accepted by a majority of former burn patients. Although long-term prospective follow-ups are needed to further validate the results, it is suggested that early screening of psychological factors could be of value in burn care.

Pedestrians are the most vulnerable road users in terms of traffic safety. Public transit users mostly have a pedestrian trip before and/or after the transit one. Thus, pedestrian activity is produced at transit stops naturally. The main focus of this study is pedestrian safety problems around transit stops, more specifically bus stops. The proposed methodology first includes Geographic Information Systems (GIS) analyses of the pedestrian safety along the study corridors and around bus stops on them / this enables determination of accident-prone corridor segments and bus stops, respectively. Later, two analyses are studied to understand their correlation. Finally, linear regression analyses are performed to find the significant factors affecting pedestrian safety. These analyses use parameters created in the GIS analyses in the first part, as well as others (i.e. built environment, traffic network, etc.) that have potential impact on pedestrian movement or safety. In corridor safety models, the number of pedestrian accidents or accident density (or some transformation of them) is used as the dependent variable / while it is selected as the total number of accidents within a selected buffer zone in the bus stop safety models. The case study corridors are selected based on the high density of pedestrian accidents in Ankara, including the Central Business District (CBD) and four main arterials serve from CBD to different regions. The bus stops on corridors with high motorized and pedestrian flows are found to be more critical than others.

The present study evaluated genetic and metabolic factors influencing the risk of acute cerebrovascular disease (CVD) and internal carotid artery stenosis (ICA stenosis) in a Swedish community. The threonine (T) containing protein of the FABP2 A54T gene polymorphism has a greater affinity for long chain fatty acids (FFAs) than the alanine (A) containing protein. This altered affinity for FFAs has been shown to affect the intestinal absorption of fatty acids and consequently the fatty acid composition of serum lipids, in particularly postprandially. Endothelium derived NO is a potent vasodilator and antiatherogenic agent. Asymmetric dimethyl arginine (ADMA) is an endogenous competitive inhibitor of endothelial nitric oxide synthase (eNOS). ADMA has been shown to be involved in the pathogenesis of atherosclerotic disease, and ADMA inhibits eNOS by displacement of L-arginine from the enzyme, which in turn is believed to affect the amount of NO available within the endothelium. The FABP2 A54T gene polymorphism was analyzed in 407 patients with acute CVD and also in a subset of these patients whose carotids had been evaluated with ultrasound. Both the FABP2 polymorphism and a common polymorphism of the eNOS gene, Glu298Asp, were analyzed in a different population consisting of 54 matched pairs of patients with ICA stenosis and controls. ADMA levels were measured in both study populations. We found that the T54 allele was more frequent in patients with transient ischaemic attacks (TIA), and that the TT genotype was more prevalent in young, non-smoking patients with CVD than in controls. Increased concentrations of ADMA were observed in cardio-embolic infarction and TIA, but not significantly in non-cardio-embolic infarction nor in haemorrhagic stroke. In multivariate logistic regression models, CVD increased across quartiles of ADMA in all subgroups, but this association was only significant in the TIA group. A decreased arginine/ADMA ratio, a measure of NO availability was associated with CVD in the entire study population. Patients with severe carotid stenosis had significantly higher ADMA levels than the controls. Allele and genotype frequencies of the FABP2 and eNOS polymorphisms did not differ between patients with ICA stenosis and controls. Our results indicate that ADMA is a strong marker for TIA and severe ICA stenosis, and that relative defiency of arginine, measured as L-arginine/ADMA, is present in acute CVD. We also conclude that a common polymorphism of the FABP2 gene increases susceptibility to ischaemic stroke and TIA. / Figure 4 on page 17 is publshed with kind permisson from The Journal of Physiology (http://jp.physoc.org/).

Introduktion: För att en räddningsinsats på olycksplats skall lyckas är en väl fungerande kommunikation nödvändig. Kommunikationen har visat sig vara ett vanligt problem vid utvärderingar av allvarliga händelser. Patientsäkerheten kan äventyras om det brister i informationsflödet mellan aktörerna i vårdkedjan. Syfte: Syftet med studien var att undersöka ambulanspersonalens uppfattningar av informationsöverföringen mellan sjukvårdens personal på olycksplats. Studien gjordes för undersöka om det fanns omständigheter som försvårar respektive underlättar informationsöverföringen. Metod: Enkätstudie bland ambulanspersonal (n= 103). Resultat: Tolv procent  ansåg att informationsöverföringen på olycksplats fungerade helt tillfredsställande. Av respondenterna var det 16,5 % som kände sig tillräckligt utbildade för att leda sjukvården på olycksplats, män kände sig signifikant oftare tillräckligt väl utbildade än kvinnor (p= &lt; 0,02). Det var också fler män än kvinnor som kände sig säkra i rollen som sjukvårdsledning (p=&lt; 0,01).  Det framkom att både mänskliga och tekniska faktorer påverkar kommunikationen samt att olycksplatsens geografiska läge, storlek och typ också hade påverkan. Konklusion: Faktorer som försvårar kommunikationen är låg tillit till en del av den tekniska utrustningen samt känslan av att vara otrygg i rollen som sjukvårdsledare. Erfaren personal samt erfarenhet av sjukvårdsledning anses vara faktorer som underlättar kommunikationen.  Fler studier behövs om  kommunikationen på olycksplats och även validerade skalor som mäter kommunikation bör utvecklas. / Introduction: Well-functioning communication is essential for the success of rescue efforts at the scene of an accident. Problems in communication have proved to be a common occurrence in evaluations of serious incidents. Security of the patient might be adventured if there are problems in the flow of information between the actors in the chain of care. Purpose: The purpose of this study was to investigate paramedics’ experiences of the exchange of information within the medical service at the scene of accidents. The study was carried out to investigate if there were circumstances that aggravate or help the transfer of information. Method: A survey study among paramedics (n = 103). Result: Twelve percent perceived that communication of information worked completely satisfactorily. A total of 16.5 % of respondents felt well enough trained to lead the medical service at an accident scene and men felt significantly more often than women that they were well trained enough for the task (p= &lt; 0,02). There were also significantly more men who felt confident in the roll as leader of the medical service(p=&lt; 0,01).   Conclusion: Factors which make communication difficult included diminished trust in technical equipment and feelings of uncertainty in the roll of leader. Experienced personnel and leaders are seen as factors which positively affect communication. More studies concerning communication at accident scenes are needed and also validated scales for the measurement of communication skills.

De nombreux troubles ont un retentissement sur le contrôle de l'équilibre dynamique au cours de la marche. Qu'ils soient d'origine traumatique, neurologique, ou liés à la sénescence, ils limitent plus ou moins la stabilité, c'est-à-dire la capacité des sujets à récupérer de perturbations internes ou externes, et peuvent conduire à la chute. Chez les enfants, la stabilité est de plus liée aux étapes développementales. Son interprétation nécessite donc de différencier ce qui relève de l'instabilité développementale et de l'instabilité pathologique. Les techniques instrumentées d'analyse du mouvement permettent un enregistrement fiable et précis des paramètres de la marche. Des index ont été développés pour faciliter l'évaluation clinique de la marche des patients mais aucun d'entre eux ne quantifie l'aspect stabilité.Ce travail de thèse a conduit à la production d'un score quantifiant la stabilité au travers de la variabilité des paramètres spatiotemporels, enregistrés par une piste de marche électronique. Ce score, dénommé Gait Variability Index (GVI), a été appliqué à des populations, asymptomatiques et pathologiques, représentatives des différents âges de la vie : l'enfant, l'adulte et la personne âgée. Les résultats obtenus chez des patients affectés de paralysie cérébrale, d'ataxie de Friedreich ou cérébrolésés démontrent que le GVI est un outil cohérent pour l'évaluation de l'instabilité. Outre l'intérêt clinique qu'il représente, celui-ci ouvre différentes perspectives pour son application et invite à la réflexion quant à la nature perturbatrice ou régulatrice de la variabilité.